Using antibiotics correctly and avoiding resistance

Photo of antibiotics
PantherMedia / ALESSIO FURLAN

The development of was one of the great discoveries in modern medicine. They fight and can cure life-threatening infectious diseases such as , for which there was previously no effective treatment. But the improper use of means that more and more are becoming resistant to this kind of medication. So it is especially important to use them correctly.

Antibiotics can save lives, but they also relieve symptoms of bacterial infections and help us recover faster. But treatment with also has side effects. Nausea or diarrhea are common, for example.

Antibiotics are also used far too often, and improper use is widespread. This has caused many different types of to become resistant (unresponsive) to . Because has become more common, many diseases cannot be treated as well as they could in the past.

When using , it's important to know the following things to prevent and side effects:

  • Antibiotics only work against . Many infections are caused by viruses and can't be treated using – examples include respiratory illnesses such as a cough, stuffy nose, or the flu.
  • Excessive and improper use of causes side effects, and in the long term reduces their effectiveness.

What is antibiotic resistance?

In medicine, bacteria and other germs are said to be resistant if they are especially able to withstand exposure to external influences. For example, most germs that enter the stomach with food will be killed by stomach (gastric) acid. But some are covered with a mucous coating that protects them from the acid. They are resistant to gastric acid.

Resistance to works on a similar principle: The have acquired a new property that protects them from the antibiotic. Some types of can produce a substance that makes certain ineffective, for example. Bacteria that can protect themselves from several different are referred to as "multiresistant."

What causes resistance?

Many of the that are now resistant used to be sensitive to . There are a few developments that played a role in this. To put it briefly, one kind of antibiotic could originally neutralize a certain type of and then effectively stop the . But the genetic material of can change by chance, sometimes creating new properties. If they protect the from an antibiotic, then the have become resistant. These kinds of properties can also transfer from one type of to another.

If are used very often, resistant are better able to reproduce because the other non-resistant strains of are stopped. Antibiotics then no longer help against infections caused by resistant .

Which bacteria are resistant to antibiotics and why are they dangerous?

Strains of Streptococcus and Staphylococcus are often resistant to . One example is called “methicillin-resistant Staphylococcus aureus” (MRSA). Staphylococci can be found on skin and mucous membranes and may cause – for example if they get into open wounds.

Resistant strains have now developed in other types of , such as Escherichia coli, Klebsiella and pseudomonads.

What is being done about antibiotic resistance?

In Germany, are prescription-only. This means that doctors are first and foremost responsible for careful and appropriate use. They are to first see whether someone actually has a bacterial . If they do, then it's important that the antibiotic is prescribed at the right dose and for long enough, and that the right antibiotic is selected that will most effectively fight the .

There are also hygiene regulations to keep resistant from spreading further and preventable infections from occurring. These measures are especially important inside of a hospital. Antibiotics are used there relatively frequently, so resistant germs can develop quite quickly. If you come into contact with someone who has an of resistant , it can help to wear disposable gloves, a mask and coat, and to use a hand disinfectant to stop the spread of the germs.

Antibiotics are also used in veterinary medicine and in agriculture. Veterinarians also have to comply with the rules for handling properly.

What can I do to prevent antibiotic resistance?

Being cautious when taking can help prevent both antibiotic and side effects.

The most important thing is to not overestimate what can do: Patients often expect to be prescribed to treat medical conditions for which they are not suitable.

Antibiotics are needed to treat serious bacterial infections like lung infections or meningitis ( of the membranes lining the brain and spinal cord). This is not the case when, for example, people who are otherwise healthy have respiratory infections caused by viruses, such as a cold or influenza (“the flu”). Antibiotics will usually be of no help because they only fight . Antibiotics also have side effects including allergic reactions, stomach and bowel problems, nausea and fungal infections. Because of these associated risks, it's important to carefully consider the advantages and disadvantages of taking .

What's important to consider when taking antibiotics?

Antibiotics should be taken for as long as the doctor has prescribed them. Just because the symptoms of the illness subside, it doesn't mean that all of the germs have been killed. Remaining may cause the illness to start up again.

If there are some tablets left over, they should not be kept for later use or given to other people. Leftover medication can be disposed of in the normal garbage or dropped off at some pharmacies. Pharmacies are not obligated to accept opened medicine though. It is important not to dispose of the medication by pouring it down the drain or flushing it down the toilet. That is bad for the environment and also contributes to bacterial .

Medications can only work properly if they are used correctly. It's important to know the following things when taking :

  • Can the tablets be broken into smaller pieces to make them easier to swallow? Doing this can stop some medications from working properly.
  • What food can you take with? Antibiotics are usually taken with water because taking them together with fruit juices, dairy products or alcohol can affect how the body absorbs some drugs. Dairy products include milk as well as butter, yogurt, and cheese. After taking an antibiotic you may need to wait for up to three hours before eating or drinking any dairy products. Grapefruit juice and dietary supplements containing minerals like may also work dampen the effect of .
  • When should you take ? Some are always meant to be taken at the same time of day, others are meant to be taken before, with or after a meal. If you are supposed to take the medicine three times a day, for example, it usually needs to be taken at set times so that the effect is spread out evenly over the course of the day. You could remember the regular times of 6 a.m., 2 p.m. and 10 p.m. for an antibiotic that needs to be taken every 8 hours, for example.
  • Can you take together with other medications? Because can interact with other medications, it's important to tell your doctor if you take other medications too. Antibiotics might interact with some blood thinners and antacids, for example. Some can make birth control pills less effective.

You can find detailed information on the use of a specific antibiotic in the package insert. If you're not sure about what is important to consider when taking the antibiotic, you can ask your doctor or pharmacist.

Bundesministerium für Gesundheit (BMG), Bundesministerium für Ernährung und Landwirtschaft (BMEL), Bundesministerium für Bildung und Forschung (BMBF). DART 2020. Zwischenbericht anlässlich der WHA 2016. May 2016.

Centers for Disease Control and Prevention (CDC). Antibiotic / Antimicrobial Resistance. June 12, 2017.

Deutsche Gesellschaft für Infektiologie e.V. (DGI). S3-Leitlinie: Strategien zur Sicherung rationaler Antibiotika-Anwendung im Krankenhaus. AWMF-Register-Nr.: 092-001. December 15, 2013.

Kayser FH, Böttger EC, Deplazes P, Haller O, Roers A. Taschenlehrbuch Medizinische Mikrobiologie. Stuttgart: Thieme; 2014.

Weltgesundheitsorganisation (WHO). Antimicrobial resistance. October 2016.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on December 18, 2013
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.